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Reducing Antibiotic Overuse in Acute Bronchitis

Article: A Cluster Randomized Trial of Decision Support Strategies for Reducing Antibiotic Use in Acute Bronchitis. JAMA Intern Med. 2013;173(4):267-273.

Summary

Study evaluates decision strategy to reduce overuse of antibiotics for acute bronchitis in primary care settings.

Abstract

Background National quality indicators show little change in the overuse of antibiotics for uncomplicated acute bronchitis. We compared the effect of 2 decision support strategies on antibiotic treatment of uncomplicated acute bronchitis.

Methods We conducted a 3‑arm cluster randomized trial among 33 primary care practices belonging to an integrated health care system in central Pennsylvania. The printed decision support intervention sites (11 practices) received decision support for acute cough illness through a print‑based strategy, the computer‑assisted decision support intervention sites (11 practices) received decision support through an electronic medical record–based strategy, and the control sites (11 practices) served as a control arm. Both intervention sites also received clinician education and feedback on prescribing practices, as well as patient education brochures at check‑in. Antibiotic prescription rates for uncomplicated acute bronchitis in the winter period (October 1, 2009, through March 31, 2010) following introduction of the intervention were compared with the previous 3 winter periods in an intent‑to‑treat analysis.

Results Compared with the baseline period, the percentage of adolescents and adults prescribed antibiotics during the intervention period decreased at the printed decision support intervention sites (from 80.0% to 68.3%) and at the computer‑assisted decision support intervention sites (from 74.0% to 60.7%) but increased slightly at the control sites (from 72.5% to 74.3%). After controlling for patient and clinician characteristics, as well as clustering of observations by clinician and practice site, the differences for the intervention sites were statistically significant from the control sites (P = .003 for control sites vs printed decision support intervention sites and P = .01 for control sites vs computer‑assisted decision support intervention sites) but not between themselves (P = .67 for printed decision support intervention sites vs computer‑assisted decision support intervention sites). Changes in total visits, 30‑day return visit rates, and proportion diagnosed as having uncomplicated acute bronchitis were similar among the study sites.

Conclusions Implementation of a decision support strategy for acute bronchitis can help reduce the overuse of antibiotics in primary care settings. The effect of printed vs computer‑assisted decision support strategies for providing decision support was equivalent.

Interview with Ralph Gonzales, MD, MSPH, author of A Cluster Randomized Trial of Decision Support Strategies for Reducing Antibiotic Use in Acute Bronchitis.

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Reducción del uso excesivo de antibióticos para tratar la bronquitis aguda

Artículo: Ensayo aleatorizado por grupos sobre estrategias de apoyo a la toma de decisiones para reducir el uso de antibióticos en el tratamiento de la bronquitis aguda. JAMA Intern Med. 2013;173(4):267-273.

Summary

En el estudio se evalúa la estrategia de toma de decisiones para reducir el uso excesivo de antibióticos para tratar la bronquitis aguda en la atención primaria.

Entrevista con Ralph Gonzales, MD, MSPH, autor de Ensayo aleatorizado por grupos sobre estrategias de apoyo a la toma de decisiones para reducir el uso de antibióticos en el tratamiento de la bronquitis aguda.

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Réduction de la surutilisation des antibiotiques dans le traitement de la bronchite aiguë

Article: Essai randomisé par grappes sur les stratégies d’aide à la décision pour une réduction de l’utilisation des antibiotiques dans le traitement de la bronchite aiguë. JAMA Intern Med. 2013;173(4):267-273.

Summary

Une étude évalue la stratégie décisionnelle à mettre en œuvre dans un contexte de soins primaires afin de réduire la surutilisation d'antibiotiques dans le traitement de la bronchite aiguë.

Entretien avec Ralph Gonzales, MD, MSPH, auteur de Essai randomisé par grappes sur les stratégies d’aide à la décision pour une réduction de l’utilisation des antibiotiques dans le traitement de la bronchite aiguë.

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Riduzione dell'uso eccessivo di antibiotici nel trattamento della bronchite acuta

Articolo: Studio clinico randomizzato a cluster delle strategie di supporto decisionale per ridurre la prescrizione di antibiotici per la bronchite acuta. JAMA Intern Med. 2013;173(4):267-273.

Summary

Lo studio valuta la strategia decisionale per ridurre l'eccessiva prescrizione di antibiotici per trattare la bronchite acuta negli ambulatori dei medici di base.

Intervista a Ralph Gonzales, MD, MSPH, autore di Studio clinico randomizzato a cluster delle strategie di supporto decisionale per ridurre la prescrizione di antibiotici per la bronchite acuta.

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减少急性支气管炎患者抗生素的过度使用

文章: 减少急性支气管炎治疗中抗生素使用的决策支持策略的整群随机试验。 JAMA Intern Med. 2013;173(4):267-273.

Summary

研究评估了决策策略对减少初级保健机构中急性支气管炎患者过量使用抗生素的效果。

专访 Ralph Gonzales, MD, MSPH, 作者 减少急性支气管炎治疗中抗生素使用的决策支持策略的整群随机试验。

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Reducing Antibiotic Overuse in Acute Bronchitis

статья: A Cluster Randomized Trial of Decision Support Strategies for Reducing Antibiotic Use in Acute Bronchitis. JAMA Intern Med. 2013;173(4):267-273.

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Интервью с Ralph Gonzales, MD, MSPH автор A Cluster Randomized Trial of Decision Support Strategies for Reducing Antibiotic Use in Acute Bronchitis.

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Reducing Antibiotic Overuse in Acute Bronchitis

Artigo: A Cluster Randomized Trial of Decision Support Strategies for Reducing Antibiotic Use in Acute Bronchitis. JAMA Intern Med. 2013;173(4):267-273.

Summary

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Abstract

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entrevista com o Ralph Gonzales, MD, MSPH autor de A Cluster Randomized Trial of Decision Support Strategies for Reducing Antibiotic Use in Acute Bronchitis.

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Senkung der übermäßigen Verschreibung von Antibiotika bei akuter Bronchitis

Artikel: Cluster-randomisierte Studie zu Entscheidungshilfen-Strategien zur Reduzierung des Antibiotika-Einsatzes bei der akuten Bronchitis. JAMA Intern Med. 2013;173(4):267-273.

Summary

Studie prüft, ob die übermäßige Verschreibung von Antibiotika bei akuter Bronchitis in der Primärversorgung durch eine Entscheidungsstrategie gesenkt werden kann.

Interview mit Ralph Gonzales, MD, MSPH, autor Cluster-randomisierte Studie zu Entscheidungshilfen-Strategien zur Reduzierung des Antibiotika-Einsatzes bei der akuten Bronchitis.

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